Portland Medicare Fraud Attorneys

Oberheiden, P.C. is a healthcare law defense firm with experience in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our firm boasts talented attorneys with years of relevant experience and education from some of the best schools, such as Harvard and Yale Law Schools and are former federal prosecutors. Our attorneys serve clients in Portland and throughout Oregon.

Portland, Oregon healthcare providers and companies face the risk of investigation for Medicare fraud. The risk in Portland is higher than the national average. If you’re under investigation for Medicare fraud, you need an attorney serving Portland and surrounding areas. Dr. Nick Oberheiden is a Harvard-trained healthcare fraud defense attorney and managing partner of Oberheiden, P.C.

Defining Medicare Fraud

Medicare fraud is a federal offense. It is a civil or criminal liability. Medicare fraud doesn’t mean only Medicare. It covers the submission of false claims to any federal government healthcare program. Tricare, Medicaid, and federal workers’ compensation are other programs under this law. Medicare fraud is a violation of one or more of the following federal statutes:

• Physician Self-Referral Law (Stark Law)
• False Claims Act
• Anti-Kickback Statute
• U.S. Criminal Code
• Social Security Act

Medicare fraud is when a medical provider or company files a false claim to a federal healthcare program for payment.

Portland and its surrounding areas get more attention because it is one of fifteen locations in the United States closely monitored by a Medicare Fraud Strike Force. Portland has a large population of federal healthcare program recipients. This increases the number of claims filed. The filing of so many claims is the main reason the government keeps a close eye on the area. The Medicare Fraud Strike Force monitors, investigates, and prosecutes Medicare fraud.

The Medicare Fraud Strike Force is a team of investigators and prosecutors from various federal agencies. Officials from any federal agency involved in fraud detection can be part of an investigation.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

Billing Mistakes in Portland: The Main Cause of Medicare Fraud Investigations

The majority of Medicare fraud investigations in Portland, Oregon are because the federal government has reason to believe a crime has taken place. The government usually suspects an individual or a business of using fraudulent billing practices or reimbursement requests. This may include false, unauthorized, and excessive charges. The most common issues in Portland are:

• Phantom billing (billing for services that weren’t performed)
• Billing for medically unnecessary services or equipment
• Billing for equipment or services that weren’t ordered
• Certifications for medically unnecessary supplies or services (such as medical devices or hospice care)
• Charge inflation
• Double billing for equipment, services, or treatment
• Upcoding for equipment, services, disorders, or treatment
• Overuse of services
• Overuse of equipment
• Providing or accepting kickbacks

Potential Civil and Criminal Penalties for Medicare Fraud

Medicare fraud allegations can result in serious civil and criminal penalties. If you’re under investigation for Medicare fraud, call Oberheiden, P.C. today. Civil penalties may include one or more of the following:

• Assessment of treble damages
• Civil fines of up to $11,000 per false claim
• Recoupment requests
• Non-payment of future claims
• Exclusion from federal healthcare programs
• Assessment of attorney fees

Criminal penalties are also extremely serious. They can include one or more of the following:

• A criminal record
• Heavy fines
• 10 years in federal prison for each count of Medicare fraud
• 20 years for each count of Medicare fraud resulting in serious bodily injury
• A life sentence if the Medicare fraud results in the death

Planning Your Strategic Defense

Civil or criminal charges can adversely affect your life. In addition to previously mentioned penalties, you could lose your license. You could face disciplinary proceedings. You could lose your hospital privileges. Because of the potential consequences, it is important to choose the right defense attorney. When researching, look for a Portland Medicare fraud attorney with the skills and experience for both civil and criminal cases.

There are Portland, Oregon healthcare providers and businesses that hire a healthcare attorney. Medicare or MedicAid fraud often includes additional crimes such as tax evasion, wire fraud, mail fraud, and money laundering. A healthcare attorney may understand healthcare law, but can lack experience with criminal charges, negotiations, and trials.

Others look for a Portland criminal defense attorney because they may face criminal charges. However, most Portland criminal defense attorneys don’t have experience handling federal criminal matters. They may not have experience with and knowledge of complex billing, coding, and medical utilization rules.

• A proven record of success in Medicare fraud cases
• Industry knowledge
• Deep familiarity with healthcare laws and their exceptions
• Litigation and trial experience

Once you’ve narrowed your options, ask three specific questions. The answers will tell you if the law firm has the needed experience in Medicare fraud.

• How many Medicare fraud cases have you handled in your career?
• How many of those cases resulted in neither civil, nor criminal charges, or in dismissals?
• How many Medicare fraud cases have you tried in court?

Proven Strategic Medicare Fraud Defenses

Oberheiden, P.C. provides proven defenses for our Portland, Oregon clients. Many of our attorneys are former senior prosecutors for federal healthcare programs. We then add experience as defense attorneys to create winning strategies for your case. Our priority is to lower the potential of criminal charges.

Immediate contact with the federal government. One of the best ways to help our clients is to contact the federal government right away. If the government time to investigate at length, the odds for criminal charges go up. We make immediate contact with the federal agencies involved to get answers to questions like:

• What is the investigation about?
• What prompted the investigation?
• Is this civil or criminal?
• Which federal agencies are involved in the investigation?
• Who is being investigated?
• How can the matter be resolved?

The federal government must present evidence that you’ve committed a crime. This evidence must meet a Constitutional standard known as guilt ‘beyond a reasonable doubt.’ We examine the evidence in each case and question its validity. We typically see the following results:

• Case dismissal
• No criminal charges
• Clients maintain their professional license
• Civil fine without a criminal plea
• Reducing a felony to a misdemeanor
• No prison time

Lack of criminal intent. In addition to proving that you committed a crime, the government must show that you had criminal intent. This is tough for the government to prove. Most Portland Medicare fraud investigations happen because someone made an honest mistake. The most common mistakes include:

• Relying on unqualified or untrained staff
• Inadequate supervision of staff
• Delegation and outsourcing of work to unqualified entities
• Business errors
• Human error
• Oversight
• Overwhelmed staff
• Lack of a Medicare compliance program
• Failure to keep up with changing healthcare laws and rules

Portland, Oregon and its surrounding areas have few legitimate instances of Medicare fraud. People and businesses facing allegations sometimes think they must have committed a crime. They then accept penalties with no questions asked. As a result, many can no longer work in their profession.

Oberheiden, P.C. addresses any obvious lack of criminal intent. We work to prove that although you made a mistake that should be addressed, there was no criminal intent.

Development of applicable defenses. Development of applicable defenses. Each Medicare fraud case has its own unique set of facts. Oberheiden, P.C. reviews each case thoroughly to build the best defenses. We recently handled a case where the government alleged our client fraudulently certified home healthcare services. We proved our client was protected by a recognized delegation exception rendering the certification legal. In another case, we refused to admit liability. We proved to federal prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Portland, Oregon Medicare Fraud Defense Attorneys Oberheiden, P.C. provides professional Medicare fraud defense for Portland, Oregon healthcare providers and businesses. We can help you with:

• Healthcare fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection
• Licensure or disciplinary proceedings
• Jury trials

Oberheiden, P.C. provides legal counsel for providers, businesses, and facilities in Portland, Oregon. If you’re under investigation by a federal agency, or Oregon law enforcement, call us today. Our initial consultation is confidential and free of charge.

We are available every day of the year. You can call us directly or complete our contact form.